Dr Olivares on Focal Therapy in the Management of Prostate Cancer

Ruben Olivares, MD, urologic surgeon, associate professor, urology, Glickman Urological Institute, Cleveland Clinic, discusses what sets focal therapy apart from localized radiation therapy in the management of prostate cancer.

The primary distinction lies in the approach to guidance used during treatment delivery, Olivares begins. Focal therapy employs fusion capabilities to achieve precise anatomical guidance, ensuring targeted delivery of therapy to specific areas of concern within the prostate gland, Olivares says. This precision allows for the delineation of the energy's extension, enabling the placement of probes or needles to administer treatment with meticulous control, he states. Advanced software aids in accurately mapping the intended treatment area, enhancing the effectiveness of focal therapy in prostate cancer management, Olivares explains.

Furthermore, data reveal notable advantages in terms of functional outcomes following focal treatment, according to Olivares. The incidence of post-treatment adverse effects, such as erectile dysfunction or urinary incontinence, is remarkably low, underscoring the favorable functional outcomes associated with this modality, he elucidates. However, when assessing the oncological outcomes of focal therapy for prostate cancer, the focus shifts toward long-term survival data, particularly overall survival (OS), Olivares expands.

Prostate cancer is uniquely challenging to manage due to its inherently indolent nature, necessitating extended follow-up periods to ascertain meaningful OS data, he says. Obtaining conclusive OS data for focal therapy mandates prolonged follow-up periods spanning several decades—typically ranging from 30 to 40 years, Olivares continues. Given the protracted timeline required for OS assessment, current data on focal therapy predominantly revolve around surrogate end points, such as failure-free survival (FFS) and metastasis-free survival, Olivares notes. These end points offer valuable insights into treatment efficacy and the likelihood of requiring subsequent radical interventions during follow-up, he adds. Thus, focal therapy outcomes characterized as “promising,” primarily pertain to the encouraging trends observed in terms of FFS, reflecting the potential of this approach in prostate cancer management, Olivares concludes.